Local podiatrist recognized nationally for passion, innovation
Dr. Guy Pupp, 64, is a Pennsylvania native who traveled through the halls of Penn State and Temple and has worked his way to becoming one of the top foot and ankle specialists (podiatrist) in the country. After attending medical school at Temple, Pupp moved to Oakland County in 1973, set down roots and hasn’t looked back, as he treats people at his office in Waterford Township and at Beaumont Hospital in Dearborn. In his spare time, Pupp lectures future physicians in residencies across the country and serves on the boards of organizations such as the Michigan Chapter of the American Diabetes Association and the national foundation “Save a Leg, Save a Life,” to educate about the dangers of diabetes. Pupp recently spent time with the Spinal Column Newsweekly discussing how working on feet became his passion and why his job is “eight days a week.”
You’re a board member with a foundation called “Save A Leg, Save A Life.” Please tell us about the foundation’s mission and how you became involved with it. You also serve on the Board of Directors for the Michigan Leadership Council of the American Diabetes Association. What does it mean to you to serve on the boards of recognized nationwide organizations?
GP: It’s a neat group of people and essentially our goal is to educate physicians, nurses and medical personnel about the problems associated with artural disease, diabetes and avoiding major amputation. Disability is horrible and we feel over 20 percent of the amputations that are performed can be eliminated. We can avoid those problems. It’s a non-profit group. I’m a member of the board and I met some of the people while lecturing who are actually involved in starting this organization. They’re from Florida — a vascular surgeon, a wound-care specialist. So we kind of chatted and we had the same goals, directions, and the same passion for limb salvage.
Essentially, it’s giving back to the profession. These are my passions. I’m not a golfer, so I do this eight days a week. And with diabetes comes problems with circulation, numbness in the lower extremities, and alcerations and sores and things that are difficult to heal. They become a challenge. So in my practice, I specialize in diabetic limb salvage and reconstructive foot and ankle surgery, and because of that I was invited to be a member of the Michigan Board of the American Diabetes Association. We have meetings usually every two months and then when needed, so it seems like it’s a lot more than that. We have screenings, fund-raising events, educational events, materials that we use for education pamphlets, etc. It’s a pretty involved thing, but it feels good to do it.
What were your aspirations growing up and was becoming a physician one of them? At what point in your life did you decide that you wanted to dedicate yourself to podiatry?
GP: It was peripheral. I wanted to be a paleontologist, a person who studies bones and things like that, and I just thought maybe that’s not the career for me, traveling all over the world. So, my second choice was being a physician, so I kind of shifted gears. I still had a science background, probably by about my freshman year of college. I went into medicine and I’m very happy I did it and I hope my patients are happy I did it, too.
My roommate at Penn State in undergraduate school, his uncle was a dentist in New Jersey and (my roommate) was going to either practice with his uncle, the dentist, or his other uncle who was a podiatrist, so I’d go home with him sometimes on weekends and he would come home with me and we visited his uncles and we saw the podiatrist one Saturday in his office … helping him out and watching, and I was pretty impressed with some of the stuff he was doing. He was treating kids. He did minor surgery in the office, he took sutures out, he took an X-ray on a local high school athlete who had injured their ankle and I said, “I like this,” so I started corresponding with some of the schools and that’s how I got interested, pretty much because of my roommate in undergraduate school. I liked medicine, I had two uncles who were physicians; my dad was a mechanic. I knew I wasn’t good at getting my knuckles all scraped up, fixing cars. I knew what I didn’t want to do and just liked hanging out with my uncles and going to their offices. I wasn’t sure what speciality I wanted to do but I liked medicine. I liked the fact that an old-time practitioner (I knew in Pennsylvania) used to make house calls and stuff like that. He was pretty well-respected in the area that I grew up in, in Pennsylvania. People loved him, he helped people, and he was an inspiration to me.
Tell us what kind of training a future podiatrist has to go through. Did you ever think that you would be giving lectures on podiatry and that 35 papers that you have written would be published?
GP: I went to medical school at Temple University in Philadelphia and I applied to a residency and I got accepted to a very desirous residency, with very up-to-date doctors, etc. And from that time, I just really got a fire going. It became my passion and it has kind of consumed my life. Besides all these other extracurricular things I’m involved in — residency education — I came to know over 175 residents over a period of years, so there’s lots of doctors around the country who I know and I’ve taught who have many times made me very proud. They get involved in education also and giving back to the profession.
In actuality I was pretty shy. I thought I could get up at the podium and start yacking away. I used to be jealous of those guys. Over a period of time, after one lecture and another, now it’s like second nature. I put my hand in my pocket and start yacking away and, in fact, most of the time I have the tendency, if anything, to go too long because I get caught up in the passion.
You’re also credited as being a co-inventor of an External Ring Fixator, the E-Z Frame. Please tell us about this product and how you played a part in its creation.
GP: Another way of describing this is a halo. Many people are aware of these things when they’ve seen people wear these on their head and their neck for injuries to the cervical area, etc. They look horrible. They have pins going through your tissue. Essentially, we developed a system to use the lower extremity that will compress and hold bones together in people who are impossible to heal. Some of these patients are obese, my diabetic patients who have bad bone stock, and people who have severe osteoporosis. So what we can do is we can fix fractures, realign bones and get them to walk again and allow them to heal. These are classic, traditional methods we’ve used, non-weight bearing crutches and a cast. A lot of my patients, in fact I’ll say a majority of my referral patients who are the diabetics with big problems, there’s no way they can stay on crutches and be non weight-bearing. Either that or they stay in the nursing home while they’re healing and most people won’t stay there, they sign themselves out. So what we did is — myself and an orthopedic surgeon from Port Huron and a podiatrist from Virginia — we developed this system that we can now use in our patients to allow them to put some pressure on an area after a fracture or a surgery is performed, and give them predictable healing. It’s really great.
I guess the bottom line is predictable results in very high-risk patients who before this either have a major below or above knee amputation or will be doomed to be in a wheelchair the rest of (their) life.
We understand that one of your studies pushed for a team approach to diabetic limb salvage. Just how prominent is diabetes in podiatry and exactly what damage can it cause to the foot and ankle? What are some other common issues that affect the foot and ankle that you encounter?
GP: Diabetes is an epidemic, not just in the United States, but around the world. It’s becoming so out of control and the numbers are outstanding as far as the millions of people who have diabetes, and even more so, the millions of people who are undiagnosed. We call them pre-diabetic and it’s incredible … the numbers are going up all the time despite education by people in the American Diabetes Association, family doctors, internal medicine doctors, etc. We don’t exercise as much as we used to do. We used to do a lot more walking than we do now. Our diets consist many times of fast food and … we see a lot of Type 2 diabetics. Somebody used the term “odd-age diabetics.” I have a lot of patients who are in their late 30s and early 40s who are certainly not old, but they’re now Type 2 diabetics because of their genetics or lifestyle.
So, what we’re attempting to do is educate people. Let’s get them aware of these things because it’s a problem that’s out of control. Because, when you are a diabetic, your blood-sugars are not in good control. It can affect your eyes where you develop types of vision problems, it can affect your kidneys where you might have to go on dialysis, it affects your nerves where you get numbness, it can affect your circulation, and now with some of the more recent studies, it can affect your heart. Every one of those things can be pretty doggone scary.
In my profession, with the lower extremity, we’re especially aware of people with bad circulation, people who don’t have feeling. For example, if you’re a diabetic, if you had no feeling in your feet and bad circulation, you could put your shoes or boots on in the morning and have something inside, a little rock or foreign object and just not be aware, walk all day and not have any sensation until you take your shoes off at the end of the day and maybe your socks have some bleeding.
You may take your sock off and throw it in some dirty clothes and it might be another day or so before your leg is swollen, you get a fever, chills, nausea, vomiting, and all of sudden you’ve got a big problem. I don’t want to paint a gloomy picture, but we see this way too often. Just before our conversation today, I had a call from the emergency room. There’s a diabetic who was just admitted and we’re going to have to take him to surgery tomorrow morning or later tonight because they have puss in their foot, going up their ankle and some in their leg, and it’s very sick.
What we’re going to do is get way back to the beginning and stop these complications by preventing diabetes. If you are a diabetic, I always tell my patients it’s not a disease, it’s a lifestyle: The more you feel it, the more you understand it, the more you become a key member, the better you do.
We see lots of things, because I do a lot of teaching and lecturing. I see a lot of other doctors and patients who had an unsuccessful surgery, or doctors who refer the patients because there’s a birth defect or they’ve had the trauma of being in a motor vehicle accident, bones that are crushed, or bad ankles. They’ve developed the ankle implants that are working well. Not too many years ago they weren’t really predictable. Some patients did OK, and some had horrible problems.
There are things like bunions — we now know we have a whole set of guidelines and logarithms and rules that we follow to (address) things like that, to get to where there are predictable results. If you do something, if you have a bunion and it can hurt like heck, we can get it fixed once and get it fixed correctly.
Podiatry Management Magazine has named you one of its 175 most influential podiatrists. What future goals do you have professionally and personally? What other strides do you hope will be made in the world of podiatry?
GP: I hope to practice … another eight to 10 years, the good Lord willing, and continue my involvement in medicine, the profession. I do a lot of lecturing. I like doing it. It’s something maybe I’m pretty good at. I’ve lectured at a lot of the ambassador meetings and a lot of medicine meetings concerning diabetes. The American Diabetes Association’s national meeting is in Philadelphia and I had just had a call yesterday from one of the national officers, a woman, who we’re going to start a new subgroup with as far as amputation prevention education. We’re going to get minorities involved because American-Indians, African-Americans, (Asians), a large, large cross-section disproportionally have diabetes and complications from diabetes.
I just hope again as a profession that we can continue to contribute to the health care delivery system. Again, going back to diabetes and complications, major amputations have been dramatically reduced … because of the podiatry and the lower extremity team brought in to help treat these things. Duke University just had a recent report where they had a 60-something percent reduction in their amputation rate since they brought podiatry into their wound-care clinics. It’s a pretty significant number when you think about it.
Again, hopefully, we’ll just continue to make inroads, and a lot of the members of my profession continue to integrate and get involved with the health care delivery system.